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Nursing Association Plans Medicare Hospice Service

The Vineyard Nursing Association has announced a plan to expand its services to include hospice care, directly competing with Hospice of Martha’s Vineyard, a 28-year-old Island institution which operates solely on donations, unfettered by the constraints of insurance regulations.

Vineyard Nursing Association has applied to become a licensed hospice provider certified under Medicare.

If the license and certification are approved — a process that will take 8 to 11 months — it will expand the services available for hospice care on the Vineyard by allowing the nursing association to provide hospice Medicare services. These services include payment coverage for medications, equipment, hospitalization and respite care.

“We’ve been talking about this for some time; we have always viewed ourselves as a full service home care agency,” said Vineyard Nursing Association chief executive officer Robert Tonti yesterday.

The nursing association put out a press release about the matter last Thursday.

Yesterday Mr. Tonti and his clinical director, Sandi Corr-Dolby, said VNA is already providing end-of-life care to some of its patients, and so it follows logically to become fully licensed.

“The only reason to do this is for the benefit of the patient and the community,” Ms. Corr-Dolby said. She said last year VNA provided end-of-life care to 76 patients; 21 of those patients also received care from Hospice of Martha’s Vineyard. “When we looked at our 76 patients — 55 chose not to use hospice, and we realized there was a need,” she added.

The total case load at VNA is about 250 patients. Following the closure of Martha’s Vineyard Community Services’ Visiting Nurse Service last year, VNA is now the sole home nursing agency on the Vineyard. VNA’s annual operating budget is about $3 million; about $260,000 of it comes from fund-raising. Mr. Tonti said the nonprofit organization has operated in the black for the last three years, and this year gave a profit-sharing bonus distribution to its staff.

By contrast, Hospice of Martha’s Vineyard has an annual operating budget of under $500,000, and executive director Terre Young said that this year, staff members voluntarily gave up their pay raises to help make ends meet. “We are very, very frugal; we always have been and will probably always need to be because we rely on this amazingly generous community to support us,” Ms. Young said.

The Vineyard hospice is licensed by the Massachusetts Department of Public Health, but, by choice, is not Medicare certified. The patient case load was 77 last year.

Hospice rents office space from the Martha’s Vineyard Hospital. VNA offices are located in the lower level of the Woodland business complex in Vineyard Haven.

Because it is not connected with any insurance programs, the Vineyard hospice program has wider latitude in providing services. For example, under Medicare rules a person cannot receive hospice care unless two doctors say that the person has less than six months to live. The Vineyard hospice program is not confined to end-of-life care.

“We have a freer rein for hospice services — we don’t turn people away,” Ms. Young said.

She said hospice employs a professional staff of nurses, social workers, a chaplain and bereavement counselors. “The whole family is our patient and we support them at a very complicated time of life,” she said. “I want to make certain that the community understands that we are still here — and we will continue to carry out our mission of excellent quality end of life care.”

Mr. Tonti said VNA met with board members from hospice on Jan. 28 to discuss a possible merger.

“We wanted to do this in the light of day — so we contacted hospice and suggested that the two organizations talk. And we did have a meeting and they have come back and said they would like to talk to us again,” he said, adding: “I am hopeful that we will be able to get to some agreement on how we may come together as an organization.”

Hospice board president Nancy Whipple confirmed that her group is open to more talks.

“We are willing to discuss future plans but need to come to a better partnership understanding — we do not want to just become a part of their organization,” Mrs. Whipple said.

She also said the announcement comes as no surprise. “We have had wind of this for some time,” she said, adding: “Is this a threat? No. A challenge? Yes.”

The process for VNA to become licensed takes place in two steps. It has applied to the state Department of Public Health to become licensed as a hospice; Mr. Tonti said he expects that application to be approved by May 11. Then the agency must go through the process of Medicare certification, which is expected to take several more months.

Mr. Tonti said he expects to see success on both fronts.

He said expanding into hospice care will not bring financial benefits to VNA. “In the end it will be revenue-neutral, and it will probably cost us money for the first couple of years,” he said.

“We are doing this because there is a gap. What we intend to do is provide excellent maximized benefits to our patients who need it — that is our goal,” Ms. Corr-Dolby said.

In the press release Mr. Tonti wrote:

“The new VNA hospice will grow, we believe, into an important element of the VNA’s expanding array of quality care programs which have helped Islanders heal for the past 25 years. We look forward to the next 25 years of caring for our neighbors.”

Mrs. Whipple said she wished VNA well in its new pursuit, and she also said her own organization, with its tireless corps of volunteers, is unlike any other on the Vineyard. “It is so selfless — there is no status symbol here, it is just a terrific group of people,” she said.